Provider Demographics
NPI:1437266459
Name:COMPLETE CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAPELA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-345-3336
Mailing Address - Street 1:5225 CLEVELAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691
Mailing Address - Country:US
Mailing Address - Phone:330-345-3336
Mailing Address - Fax:330-345-1190
Practice Address - Street 1:5225 CLEVELAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691
Practice Address - Country:US
Practice Address - Phone:330-345-3336
Practice Address - Fax:330-345-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2577111N00000X
OH242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2053754Medicaid
U74979Medicare UPIN
C09302671Medicare ID - Type Unspecified